10. Psychology Flashcards
hearing voice all the time + believes FBI telling him to do something
4 type Name/Criteria/Risk/Tx
Name: schizophernia
- Brief psychotic disorder: <1 month
- Schizopheniform: <6 month
- Schizophrenia: >6 month
- Schizoeffective disorder: schizophernia + mood disturbance
Criteria
- Positive sx (hallucination, delusion) - excessive dopamin
- Negative sx (flat emotional effect) - dopamin dysfuntion
- >2 of more (but must have 1 positive)
Risk: Strong family hx
Tx: Antipsychotic - 2nd gen - risperidone, olanzapine, quetiapine
hx of taking 1st gen psychotic medication + protusion of tongue, trimus, facial grimacing
Name/Medication/Tx
Name: Dystonic reaction (dyskinesia)
Medication: haloperidol, chlorpromazine
Tx: diphenhydramine IV or add benztropine
hx of taking 1st gen antipsychotic meds + repetitive move involve face and extremities such as lip smacking, rolled tongue
Name/Medication
Name: Tardive drykinesia
Medication: haloperiol, chlorpromazine(thorazine)
hx of taking 1st gen antipsychotic meds + mental status change + hyperthermia/fever
Name/Medication/Tx
Name: Neruoleptic malignant syndrome (NMS)
Medication: haloperidol, chlorpromazine (Thorazine)
Tx: Stop offending agent + cooling blanket & ice + dopamine agonist (bromocriptine)
1st gen antipsychotic
Medication/MOA/SE
Medication: Haloperidol, Chlorpromazine (Thorazine)
MOA: dopamin antagonist
SE: EPS(DR,TD)/NMS/prolactin increase/weight gain
2nd gen antipsychotic
Medication/MOA/benefit over 1st/SE
Meidcation: olanzapine, quetiapine, clozapine
MOA: dopamin/serotonin antagonist
Benefit: less EPS
SE: Clozapine must check CBC weekly due to cause agranulocytosis and myocarditis, Olanzapine cause weight gain
1st line for bipolar medication/SE/CI
Medication: Lithium
MOA: Norepi, serotonin sensitivity
SE
- hypothyroidism
- due to narrow theraputic index check serum level every 5-7 days (0.6-1.2 MEG normal, anything above 1.5 go ER),
- Increase thirst and urination (must drink 8-12 glasses of water/day)
CI: Pregnancy (teratogenic - ebstain anomaly)
Insomnia + Feeling worthless + sx has been more than 2 weeks
Name/Dx/Lab/Tx
Name: Major depression disorders
Dx: PHQ 2 (1st) - More than 3 point or above use PHQ9 -> PHQ9 more than 10 point -> start tx
Lab: TSH (hypo), anemia, Vit D
Tx
- Psychotherapy (cognitive)
- SSRI, SNRI (1st), Bupropion (2nd) - requires 3-6 weeks to determin efficacy
- If failed 2 medication therapy, add bupropion -> refer out psych
- Electroconvulsive therapy (ECT)
1st line for MDD
medication list/MOA/Benefit/SE
Q: Which mediction is not approved to use for pediatric?
Medication
- sertraline - Night meds (tends to clam down)
- citalopram, escitalopram
- paroxetine, fluoxetine - morning meds (tends to active)
MOA: Serotonin
Benefit: Less S/E, low toxicity
SE: sexual dysfunction, Serotonin syndrome (acute alter mental status, seizure)
Ans: Paroxetine
Pt has chronic pain + hot flash
Medication list/MOA/SE
Medication: Venlafaxine, desvenlafaxine, duloxetine
MOA: Serotonin, Norepi, dopamine
SE: HTN
TCA (tetracyclic antidepressants)
Medication/MOA/SE
Medication: Amitriptyline, Clomipramine, Desipramine
MOA: Serotonine & norepi
S/E: severe toxicity with overdose (anticholinergic effect, prolong QT, wide complex tachycardia)
Pt need smoking cessation help
Medication/MOA/SE/Benefit/CI
Medication: Bupropion
MOA: Dopamin & norepi
SE: weight loss
Benefit: Less GI distress & sexual dysfunction compared to SSRI
CI: hx of seizure disorder (lower threshold)
Pt states medication cause severe sedation used it for depression
Medication/SE/Benefit
Medication: Mirtazapine
SE: sedation, weight gain
Benefit: Fast action (2-3weeks effect)
spend a lot of money + grandiose + pressure speech + not sleeping enough
Name/Risk/Dx/Tx
Name: bipolar I
Risk: family hx
Dx: Mania at least 1 week
- Mood: euphoria, irritable
- thinking: racing, spending sprees, flight of ideas
- behavior: pressure speech, decrease need for sleep, pleasure activity including risk-taking, & hypersexuality
Tx: Lithium (1st), if agitation - benzo should add
- Cognitive therapy
irritably mood with 4 days clearly different from the usual nondepressed mood, but does not caused marked impairment, no psychotic features & does not requires hospitalization
Name/Dx/Tx
Name: Bipolar II
Dx: hypomania with 4 days of sx
Tx: Lithium (1st)
- Cognitive therapy
Chronic depressed mood 2 year or more + still able to function + pt states i’ve always been this way
Name/Tx
Name: persistent depressive disorder
Tx: Psycotherapy (1st), SSRI
Pt thought about future + sudden starting having chest pain, palpitation, SOB
2 type Name/possible additional/Tx
Name: Panic attack/disorder
- attack - brief attack
- Disorder: recurrent (at least 2 attack)
Possible additional: Agoraphobia - anxiety about being in places or situation
Tx: attack - benzo, Disorder - SSRI (1st), Cognitive therapy
excessive worrying more than 6 month + fatigue
Name/Dx/Tx
Name: general anxiety disorder
Dx: GAD-7 (score more than 10 tx), Review coffeine, and substance hx
Tx: SSRI with CBT (1st), Buspiron (2nd) - doesn’t cause sedation
fear of public speaking, meeting new person cause panic attack x more than 6month
Name/Tx
Name: Social anxiety disorder
Tx: CBT + SSRI
intense fear of snakes, blood, height + more than 6 month
Name/Tx
Name: specific phobia
Tx: Exposure therapy
- Maybe use short term - benzo
Re-experiencing more than 1 month (flashback) + hx of trauma
Name/Tx
Name: PTSD
Tx: SSRI + CBT
- Trazodone for insomnia
Flashback experience of trauma + less than 1 month
Name/Tx
Name: acute stress disorder
Tx: CBT, if persistant - PTSD tx
Lost of job, divorce, cause interferrence of daily function
Name/TX
Name: Adjustment disorder (temporary less than MDD)
Tx: psychotherapy, usually resolve in 6 month
Dissociative disorder 3 type and explain
- Dissociative identity disorder - presense 2 distinct identity
- Depersonalization/derealization disorder - focused on movies and unable to hear or see anything surround
- Dissociative amnesia - inability to recall personal/autobiographical information
- Dissociative fugue - abrupt change in geographic location
Recurrent thought + repetitive behavior
Name/4 major pattern/Tx
Name: OCD (obessesive-compulsive disorder (OCD)
4 Major pattern
- contamination - keep cleanning
- pathologic doubt - forget turn off iron
- symmetry/precision - perfection arrange
- intrusive obsessive thoughts - keep thinking over and over
Tx: SSRI + CBT
Pt does not like one or more of their body parts + often check mirror image of their body
Name/Tx
Name: Body dysmorphic disorder
Tx: SSRI + psychotherapy
- True sx but unable to find cause - Name/Tx
- Preoccupation with the fear or belief one has or will contract a serious disease - Name/Tx
- pt complains of neruologic dysfunction but can’t be explained clinically (paralysis, mutism, seizures) - Name/Tx
- intentional falsification of signs and symptoms but not for personal gain (creation of sx, or willing to undergo surgery) - Name/Tx
- Intentional falsification of sign and symptoms and SECONDARY GAIN - Name/Tx
- somatic disorder - Tx - regular appt with health care provider
- illness anxiety disorder (hydrocondriasis) - Tx- Regular appt with health care provider
- Conversion disorder - Tx - psychotherapy
- factitious(munch) disorder - Tx - None
- Malingering disorder - Tx - None
Abuse 3 type and examples
- Sexual abuse - genital/anal trauma, STD
- Physicial abuse - ciggarette burns, buns in a stocking glove pattern, healed fracture in X-ray, bruises
- Child neglect - malnutrition, poor hygiene and failure to thrive
BMI more than 30 + binge eating at least weekly for 3 month
Name/Tx
Name: Obesity
Tx: Orlistat, lorcaserin
Women + BMI less than 17.5
Name/PE/Dx/Lab value/Tx
Name: anorexoa nervosa
PE: hypotension, bradycardia
Dx: BMI less than 17.5
Lab: hypokalemia
Tx: Olanzepine
- hospitalization if less than 75% body weight
binge eating + purging type
Name/PE/Lab/Tx
Name: Bulimia nervosa
PE: teeth pitting or enamel erosion, Russell’s sign (calluses on the dosrsum of the hand)
Lab: HypoK, HypoMg
Tx: CBT (1st) + Fluoxetin
Classification Cluster A,B,C
Cluster A - schizoid, schizotypal, paranoid
Cluster B - antisocial, histrionic, narcissistic, boarderline
Cluster C - dependent, OCD, acoidant
pt likes to be alone + no response to praises or criticism
Name/Tx
Name: Schizoid
Tx: Psychotherapy
pt believes superstition, bizarre fantasies but no signs of delusion
Name/Tx
Name: Schizotypal
Tx: Psychotherapy
pt has significant mistrust/suspiciousness toward to others
Name/Tx
Name: Paranoid
Tx: Psychotherapy
Drunk-Driving + shows no little anxiety + often implusive and lack of empathy
Name/Tx
Name: antisocial
Tx: Psychotherapy
Significant mood swing + black & white thinking + unstable relationship
Name/Tx
Name: Boarderline
Tx: Psychotherapy (dialectic behavioral therapy)
seek for attention to others + likes to get prasises and reassurance + inappropriate sexually provocation
Name/Tx
Name: Histrionic
Tx: Psychotherapy
Grandiose often excessive of self-importance (inflated self image)
Name/Tx
Name: Narcissistic
Tx: Psychotherapy
pt with timid, shy & lack of confidence
Name/Tx
Name: Avoidant
Tx: Psychotherapy (may be use BB for anxiety)
Avoiding eye contact + no communication with others + repetitive pattern
Name/Tx
Name: Autism
Tx: Neuropsychologic testing
Constantly asking for assurance + difficulty of decision making + relies on others
Name/Tx
Name: dependant
Tx: Psychotherapy
Children with angry/irritable mood + blamming for others + arguments often with adults x 6 month
Name/Tx
Name: Oppositional defiant disorder
Tx: Psychotherapy
Children who aggressive/cruel to animal + stealing, lying, sets fire backyard + breaking law often
Name/Tx
Name: Conduct disorder
Tx: Psychotherapy (Poor prognosis) - often develop antisocial
Children 11 yo constantly talking and impatient + distract easily + hard to focus on task or hard to sitting quitely for long period time
Name/Dx/Tx/MOA stimulant/MOA nonstimulants
Name: Attention deficit hyperactivity disorder (ADHD)
Dx: on set before 12 yo, at least 6 month of period consistancy
Tx: Behavior modification + stimulants (methylphenidate, amphetamine) or nonstimulants (atomoxetine)
MOA stimulants - Block dopamin/norepi reuptake
MOA nonstimulants - Block dopamin
hx of smoking + hasn’t smoked for 2 days + restlessness
Name/Tx
Name: tabacco dependence
Tx: Counselling/CBT
- Nicotine tapering therapy - gum, transdermal, inhaler
- Bupropion
- Varenicline (Chantix)
Pupil constrict + breathing difficulty
Name/Tx
Pupil dilated + sweating + piloerections (googe bump)
Name/Tx
Name: Opioid intoxication
Tx: Naloxone (Narcan)
Name: Opioid Withdrawal
Tx: Clonidine, Buprenorphine + naloxone (suboxone)
- Methadone tapering (may use benzo)
long hx of ETOH + restlessness + tachycardia
Name/4 category/Tx
Name: Alcohol withdrawal
4 category
- Uncomplicated alcohol withdrawal - 6-24 hrs (tremor, palpitation - increase CNS)
- Withdrawal alcohol - 6 - 24hrs with generalized seizure (tonic clonic type)
- Alcoholic hallucinosis - 12-48 hrs with hallucination
- Delirium tremens - 2 - 5 days delirium + abnormal vital sign
Tx: IV Benzo (zepam meds) + IV thiamine & Mg
slurred speech + impaired attention
Name/Tx
Alcohol depence screening and management explain
Name: Alcohol intoxication
Tx: Observe
- Chronic - IV thiamine & megnesium
Alcohol dependence screen - CAGE (2 or more Consider as positive)
- Cutdown - tried?
- Annoyed - people told him
- Guilt - feel guilt?
- Eye opener - needed eye opener
Tx: disulfiram, Naltrexone
4 important Suicide risk/2 Method/Tx
Risk
- Previous attempt (strongest)
- Female attempt higher, but male complete suicide than female
- Elder white men sucide highest in US
- Marriage and children has lowest chance to sucide (protection)
Method
- gun (possesion increase chance 4 times high)
- hanging, poisoning
Tx: Safety is primary tx, counselling
death of loved one x less than 1 year
Name/Difference/Tx
Name: Grief Reaction
Difference VS MDD - self-esteem preserved (MDD - feeling worthlessness)
Tx: Psychotherapy
